Provider Demographics
NPI:1477647519
Name:BERMAN, JACK ROBERT (DC)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:ROBERT
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 N.E. 163 STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH MAIN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:305-940-2225
Mailing Address - Fax:305-940-6323
Practice Address - Street 1:3733 N.E. 163 STREET
Practice Address - Street 2:
Practice Address - City:NORTH MAIN BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160
Practice Address - Country:US
Practice Address - Phone:305-940-2225
Practice Address - Fax:305-940-6323
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH003524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102312100Medicaid
FL050161100Medicaid